Breast Cancer: No Need For Chemotherapy?

Chemotherapy, the powerful medications used to destroy cancer cells, has a reputation for causing difficult side effects. If you or someone you love has been diagnosed with breast cancer, you may be worried about the effects of chemotherapy. But according to a new study, about 70 percent of women diagnosed with the most common type of breast cancer can safely forgo chemotherapy as part of their breast cancer treatment plan.

How Do You Know If You Can Skip Chemotherapy?

The chemotherapy study results don't apply to everyone with breast cancer. We're specifically talking about women who've been diagnosed with HR-positive, HER2-negative breast cancer that has not spread to lymph nodes, which is the most common type. Also, the tumor has to have a certain "score" based on a genetic test we perform.

It's been standard practice to get a small sample of tissue from the tumor (during a test called a biopsy) and perform genetic testing. The most commonly used test, called Oncotype DX, assesses how likely it is that the tumor will return in the next 10 years.

We've known that women whose tumors had a low risk of returning didn't need chemotherapy. Likewise, we knew that women whose tumors had a high risk of coming back did benefit from chemotherapy.

But for the women whose tumors fell in the middle, we weren't sure if chemo helped. The research from the TAILORx study now tells us that most women in the intermediate risk group don't need chemotherapy.

What Other Breast Cancer Treatments Are There?

We can treat breast cancer with surgery, radiation, chemotherapy and endocrine therapy (also called targeted hormone therapy). Endocrine therapy works by blocking or turning off the production of hormones like estrogen and progesterone. (It's the opposite of hormone replacement therapy that some women get during menopause, which increases the levels of those hormones.) For most women, cancer treatment usually involves a combination of these methods.

The TAILORx study compared a group of women who had both endocrine therapy and chemotherapy with a group that received only endocrine therapy. Both groups of women were in that middle category – they had tumors that were considered an intermediate risk for returning. The results showed little difference between the survival rates of the groups, which means that for most women with intermediate-risk tumors, chemotherapy isn’t necessary.

We want to give women the precise treatment they need, no more and no less. Knowing who chemotherapy works best for really helps us better tailor a woman's treatment.

What Should Women Who Have Been Newly Diagnosed Discuss With Their Doctors?

You can ask your oncologist whether you're an appropriate candidate for genetic testing of the tumor. If you are, the results can tell you and your oncologist what additional treatment is needed – endocrine therapy alone or with chemotherapy – as well as your long-term prognosis.

What Steps Can Women Take to Prevent Breast Cancer?

Genetic testing may be beneficial if you have a family history of breast cancer or ovarian cancer. This testing checks to see if you have a gene that increases your risk of developing those types of cancers. The best way to decide whether to get genetic testing is to meet with a genetic counselor who can evaluate your family history and recommend appropriate testing.

Women 40 years and older should talk to their doctors about their risk factors and when they should start getting screened.

High-risk individuals may need to get screened at a younger age, more frequently or require more advanced testing like a breast MRI.

Living a healthy lifestyle is also beneficial and includes:

Maintaining a healthy weight (a body mass index (BMI) lower than 25)

Getting at least 30 minutes of aerobic exercise per day

Limiting alcohol consumption

Limiting use of hormone replacement therapy

Protecting Breast Health

At Franciscan Health, we have a variety of tools to support the prevention and care of breast cancer. If you've been diagnosed with the condition, you may need a consultation with one of our cancer specialists, the guidance of a breast cancer nurse navigator and the camaraderie that a breast cancer support group can provide.

If early detection is your primary focus, we offer traditional and 3D mammograms as well as breast MRIs and genetic counseling services for those at higher risk. Whatever your concern, we're here to help.

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Nurse practitioners (NP) are advanced practice registered nurses that manage acute and chronic medical conditions, both physical and mental, through history and physical exam and the ordering of diagnostic tests and medical treatments. NPs are qualified to diagnose medical problems, order treatments, perform advanced procedures, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions within their scope of practice. Their education includes a Bachelor of Science in Nursing (BSN) or other undergraduate degree, and requires a license as a registered nurse (RN) and experience as an RN in a health care setting. They must graduate from an accredited graduate (MSN) or doctoral (DNP) program and achieve a board certification.

Physician assistants (PA) typically obtain medical histories, perform examinations and procedures, order treatments, diagnose diseases, prescribe medication, order and interpret diagnostic tests, refer patients to specialists as required, and first or second-assist in surgery. Their education includes a bachelor’s degree, extensive clinical training from an accredited PA program and they must obtain a license to practice as a physician assistant.